Provider Demographics
NPI:1831392174
Name:MINTON, CHALLIE A (MD)
Entity type:Individual
Prefix:DR
First Name:CHALLIE
Middle Name:A
Last Name:MINTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:113 SCENIC OUTLET LN STE 2
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-9978
Mailing Address - Country:US
Mailing Address - Phone:336-352-4900
Mailing Address - Fax:336-352-4901
Practice Address - Street 1:113 SCENIC OUTLET LN STE 2
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-9978
Practice Address - Country:US
Practice Address - Phone:336-352-4900
Practice Address - Fax:336-352-4901
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2009-01632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC58996Medicaid